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Insurers paying doctors faster, despite inefficiency

By Robert Weisman
Globe Staff / May 26, 2010

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US health insurers are paying doctors seven days faster, on average, and denying 12 to 18 percent fewer claims than last year, but the claims reimbursement system remains saddled with inefficiency, according to a new ranking of payers set to be released today.

While most private insurers have made progress in using technology to accelerate medical claims processing, state-run Medicaid programs across the country continue to lag, the report shows, even as the states prepare to add tens of millions of newly insured individuals to their rolls under the national health care law.

The largest Massachusetts health insurance carriers ranked among the most efficient payers nationwide, with Blue Cross Blue Shield of Massachusetts placing third, Tufts Health Plan in sixth place, and Harvard Pilgrim Health Care 14th, out of 137 insurers studied.

The most efficient insurer overall was Humana Inc., based in Louisville, Ky.

Athenahealth Inc., a Watertown company that helps doctors handle billing and records, compiled the fifth annual PayerView rankings in collaboration with the Physicians Practice management journal, drawing on a database of 24,000 health care providers in 45 states.

Their report focused on transactions between payers and providers, not on premium rates charged to businesses and consumers.

The findings showed improvements from last year in the study’s measures, such as how many days it takes to pay claims and the percentage of claims denied.

But they also showed the majority of back-office operations at hospitals, doctors offices, and insurers remains slow and disorganized because the fragmentation of the health care industry makes it difficult to establish standards for technology and transactions.

“It’s mind-boggling how much waste there is,’’ said Jeremy Delinsky, senior vice president at Athenahealth. “Health care transactions in the United States are not done in real time the way transactions are done in almost every other industry. Even in the fastest cases, it can still take three weeks for doctors to get paid.’’

Cynthia Childs, administrator at Heywood Medical Group, a doctors practice in Central Massachusetts, said billing remains one of the most stressful parts of the business. “Every carrier has different rules,’’ she said, “and some even have different codes for the same rules. You have to know that or you don’t get paid.’’

Nationwide, it took providers in the Athenahealth database an average of 39 days to get paid in the first quarter, and about 7 percent of claims were denied.

Blue Cross Blue Shield reimbursed providers in 19.6 days on average last year, 14 percent faster than the 22.8 days it took in 2008. Tufts Health Plan paid its claims in 28.9 days, on average, 11.9 percent faster than 32.8 days the prior year.

Harvard Pilgrim Health Care, of Wellesley, paid in an average of 38 days, 4.3 percent faster than the previous 39.7 days. Fallon Community Health Plan, based in Worcester, paid providers in 40.3 days, on average, 4 percent faster than 42 days a year earlier.

The only large insurer in the state that did not quicken its claims-paying was MassHealth, the state government Medicaid plan, which took an average of 56.1 days last year and in 2008.

On the claims denial measure, Tufts and Harvard Pilgrim each rejected 4.4 percent of the claims submitted by the health providers surveyed last year. Fallon rejected 5.8 percent of claims, Blue Cross Blue Shield 6.4 percent, and MassHealth 23.1 percent.

Robert Weisman can be reached at weisman@globe.com.